Hansen's Disease

Prevention

The Lower Extremity Amputation Prevention (LEAP) Program outlines the steps for patient self-care of the insensitive foot.  The program consists of five activities.

Patient Education

Prevention of injury begins with educating patients about the condition causing neuropathy and the proper self care techniques.  All of the following activities should be explained and monitored on follow-up visits.  The patient must realize the importance of taking responsibility for self care to ensure healthy feet.

Annual Foot Screening

Annual screening is recommended to detect signs and symptoms of high risk feet.  Barring problems, yearly screens are recommended to monitor any changes in neurological status.  Any change in status may require a change in treatment protocol (possibly a different style of shoe or orthotic).

Appropriate Footwear Selection
(Suggestions for over-the-counter shoe selection)

• NO barefoot walking!   A person with insensitive feet must always wear shoes but the shoes must be appropriate.  The shape of the shoe must match the shape of the foot.

• Always have the feet measured when buying shoes.  There should be a 1/2" space between the length of the longest toe and the shoe.

• You should also be able to pinch a small area at the widest part of the shoe to determine sufficient width.

• The toe box (end of the shoe) should be roomy enough to accommodate the toes.

• Leather uppers are preferable because over time the leather conforms to the shape of the foot.

• Purchase shoes with a wedge and soft rubber sole.

• No high heel shoes - they tend to put more pressure on the forefoot.

• A shoe with a closure system.  Clogs, slip-ons or loose fitting shoes may easily come off the foot or rub red areas.

• Gradually break in new shoes.  Begin wearing new shoes no more than 2 hours the first wear and gradually progress with more time if no problems are noted.

• For details and indications for special footwear view our footwear section.

Daily Self-Inspection of the foot by the patient

• Inspect feet daily for redness, warmth, swelling or any other new injury.  Use a mirror to check the bottom of your feet.

• Always wear socks with shoes and inspect them daily.  White cotton socks are preferable because they are more absorbent and white allows evidence of skin breakdown and drainage to be easily seen.

• Inspect shoes before and after wear to ensure no objects have accidentally fallen into the shoe or any sharp items have penetrated the soling.

Management of Simple Foot Problems

• Cut toenails straight across.  If nails are large and irregular in shape, professional care may be necessary.

• Do not cut calluses or corns or use corn removers.  These are problems which should be addressed by a health care professional.

• If any new injury or redness, swelling or temperature are noted, it should be brought to the attention of a health care professional.

• For dry skin, use a lotion that does not contain alcohol.

• Never use heating pads, hot water bottles or stand too close to a heater or fireplace.  Insensitive feet and lower legs may not detect when temperatures have reached dangerous levels, and burns can result.